Healthcare Provider Details

I. General information

NPI: 1174619068
Provider Name (Legal Business Name): LARRY W COLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 INTERNATIONAL CIR SUITE 200
COLORADO SPRINGS CO
80910-3152
US

IV. Provider business mailing address

3245 INTERNATIONAL CIR SUITE 200
COLORADO SPRINGS CO
80910-3152
US

V. Phone/Fax

Practice location:
  • Phone: 719-484-8840
  • Fax: 719-484-8845
Mailing address:
  • Phone: 719-484-8840
  • Fax: 719-484-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number17452
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: